Public Policy

Working with federal and state lawmakers and executive agency personnel

To fulfill its mission to improve the quality of health care, NCQA works with federal and state lawmakers and executive agency personnel. NCQA Public Policy team provides information and comment letters for its government partners. Federal work includes on Medicare Advantage plans, health information technology, and on delivery system reforms such as Patient Centered Medical Home. The Public Policy Department helps state and federal policymakers understand and use NCQA programs to improve the quality, experience and cost of care. NCQA also work in coalition with consumer, employers and other stakeholder groups to advance policies that will improve the quality and efficiency of the health care system.

Federal Policy

At the federal level, NCQA Accreditation, quality measures and patient-centered clinical programs are valued components of health care policy. Both the Affordable Care Act of 2010 and the Medicare Access & CHIP Reauthorization Act of 2015 include many provisions that support and build on NCQA’s mission and capabilities. This includes provisions promoting Patient-Centered Medical Homes, Patient-Centered Specialty Practices, use of quality measures to pay both health plans and clinicians for value, and NCQA’s performance-based Health Plan Accreditation.

Delivery Systems Reform

NCQA has several programs to help health care providers, plans and public payers improve how care is delivery to get better quality, experience of care and costs. These include our:


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Comment Letters

NCQA Comments on Stark Self-Referral Law
NCQA urges CMS to waive Stark self-referral rules for Alternative Payment Models to promote and enhance value-based care.

NCQA Endorses HR4952
NCQA endorses Reps. Kelly & Kind's bill requiring HHS to study & report on the Medicare Advantage benchmark cap that prevent high-quality plans from getting bonuses they have earned.

NCQA Comments on CMS Direct Provider Contracting RFI
NCQA urges CMS to limit DPCs to high-value PCMH & PCSP providers, and to prohibit DPC clinicians from charging more than Medicare payment limits.

NCQA Supports Medicaid Behavioral Measure Reporting
NCQA supports draft legislation to require state reporting of Medicaid Adult Core Set behavioral measures to help fight opioids.

NCQA Comments on Proposed Medicare Advantage Rules
NCQA supports opioid limit and value-based insurance design proposals.

NCQA Comments on Final Rule for QPP Year 2
NCQA provides feedback on the final rules for Quality Payment Program Year 2.

NCQA Comments on Proposed 2019 ACA Exchange/Marketplace Rules
NCQA urges CMS to rely on Exchange-specific accreditation and address disparities via stratification.

NCQA Comments on CMMI's New Direction
NCQA provides feedback on the CMS Request for Information regarding the Innovation Center's New Direction.

NCQA Response to Ways & Means Provider Statutory & Regulatory Relief Initiative
NCQA provides feedback to W&M on how to reduce provider burden in quality measurement. 

NCQA Responds to CMS RFI on ACA Burdens
NCQA urges CMS to allow deeming for accredited Exchange plans, and to reduce clinical quality measure reporting burden by moving to well-designed & tested electronic clinical quality measures.

NCQA Comments on 2018 Quality Payment Program Proposed Rule
NCQA provides feedback on proposed updates to the Quality Payment Program for CY2018

NCQA Patient Choice and Quality Care Act Endorsement
NCQA supports bipartisan legislation to improve advanced and end-of-life care.

Medicare Advantage & MACRA APMs
NCQA and eight other leading health groups are urging CMS to give clinicians MACRA Advanced APM credit for participating in Medicare Advantage APMs.

NCQA MA RFI Comments
NCQA urged CMS to add behavioral measures to the Medicare Advantage Star Ratings and remove the benchmark cap that prevents some high quality plans from getting bonuses they have earned.

Medicare Advantage RFI Behavioral Sign-on Letter
NCQA and 15 consumer and behavioral health advocacy groups urged CMS to add behavioral measures to the Medicare Advantage Star Ratings.

NCQA Comments on RFI for PACE and P3C
NCQA provides feedback on RFI for new and existing models of integrated care.

NCQA and 120+ Groups Support Value-based Reforms
NCQA and more than 120 other leading health care organizations are urging Congress to continue focusing on value-based, patient-centered reforms.

NCQA Comments on Final MACRA Rule
NCQA provides comment on the final rule for implementing the Medicare Access & CHIP Reauthorization Act (MACRA). 

NCQA Comments on State Innovation Model RFI
NCQA provides feedback on questions and concepts related to state-based delivery and payment reform initiatives.

NCQA Comments on Proposed 2016 Physician Fee Schedule
NCQA offers feedback on proposed changes to the PFS, highlighting support for proposals to strengthen primary care and patient-centered care management.

NCQA Comments on Patient Relationship Categories and Codes
NCQA recommends that CMS develop an automated decision tree to attribute patients to clinicians for measurement in the Merit-Based Payment Incentive System (MIPS).

NCQA Comments on MACRA Measure Development Plan 

NCQA Comments on SAMHSA Privacy Updates
NCQA supports SAMHSA proposal to modernize privacy standards to encourage better care coordination and data sharing.

NCQA Comments on Proposed Star Ratings System for Duals
NCQA provides feedback on CMS' effort to develop a star rating system for Financial Alignment Initiative Medicare-Medicaid Plans.

NCQA Comments on Risk Adjusting Medicare Advantage Payment for Duals
NCQA supports CMS' plan to pay Medicare Advantage plans more for the higher cost of serving enrollees eligible for both Medicare and Medicaid. 

A Future Vision of Medicare Value-Based Payment
NCQA is proposing 5 key principles for value-based payment under the new Medicare Access & CHP Reauthorization Act (MACRA).

NCQA Comments on Medicaid Managed Care Proposed Rule
NCQA supports harmonizing Medicaid rules with those for Medicare and Marketplace plans, but does not believe states should apply private accreditor standards.

NCQA Comments to NQF on SES Risk Adjustment